Examination

A general examination of all the major systems of a patient normally supplements the clinician's history taking. In the case of paediatric examination, in particular, it should include the measurement of parameters of growth -height, weight and head circumference - which should be recorded on an appropriate centile chart. Chronic illnesses such as coeliac disease and poorly controlled asthma may result in a thin, short child, as do the use of long-term high-dose steroids.

The examination of the patient suspected of having an allergy to a food then focuses upon the presence or absence of signs associated with other atopic diseases. This not only establishes whether the individual has an atopic disposition, but also may identify signs resulting from, or exacerbated by, their food allergy.

The signs of eczema and atopic dermatitis have proved difficult to define.17 The acute signs include erythematous (red) and vesicular (blistered) skin. More chronically one finds lichenified (thickened), oedematous (swollen) and cracked areas of skin. The picture and distribution is slightly different depending upon the age of the patient.

The physical examination of a patient who lists urticaria and/or angioedema as their symptom is often unremarkable. There should be a particular emphasis on the search for the signs of other systemic illnesses known to be associated with urticaria. Any urticarial lesion should be noted, such as an itchy well-demarcated raised area, often with surrounding erythema.

Patients with perennial or seasonal rhinoconjunctivitis may have injected conjunctivae (visible small blood vessels), erythematous conjunctivae (reddened whites of eyes), puffy eyelids, and erythematous, oedematous nasal mucosa (the lining of the nose appearing swollen and red). Studies investigating any link between food allergy and otitis media with effusion (sometimes termed glue ear - long-standing fluid in the middle ear resulting in, albeit temporary, conductive hearing loss) have been poorly conducted.18 To date, there is no good evidence linking this condition with food allergy.

Asthma is more usually diagnosed by history and if necessary confirmed by lung function tests. Examination may rarely reveal the acute signs of respiratory distress and wheeze associated with asthma, or more chronic changes, such as Harrison's sulci (a change in shape of the lower rib cage).

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